"Manadala meeting", advance notice

“We are always beginners in the art of compassion” Christina Feldman

Dear Friend

The next monthly meeting will be held on Saturday, 8th November 2008 at 2.00 pm in the Doric Room at Friends House, Euston Road, London. Nearest Underground stations are Euston, Euston Square and Kings X/St Pancras (all within reasonable distance for pedestrian or wheelchair user).

We have decided from now on to call this monthly meeting the Buddhist Hospice Trust “Mandala meeting“. This inspired suggestion was made by Michael Lewin who, besides being our Treasurer, is an artist of repute.

MANDALA

Mandala is, I understand, a Sanskrit word combining the elements ‘essence’, ‘containing’ or ‘having’, and is of Hindu origin but is also widely used in Buddhism. We read that in various spiritual traditions mandalas are used in meditation for focussing attention; as a spiritual teaching tool or ‘visual aid‘; and for establishing a ‘sacred space’.

The mandala has become a generic term for any plan, chart or geometric pattern that represents the cosmos: a microcosm of the Universe from a human perspective, or a representation of the unconscious self. In the Tibetan tradition, complicated and beautiful mandalas are carefully constructed using coloured sand; when completed the mandala is quickly swept away to show the transitory nature of all material things, the sand returned to a river so that it may not be used again.

Now I wonder if you will find that that this is an appropriate label to apply to our meetings? I think so myself; in fact I experienced a shiver of recognition down my spine when Michael suggested it - I can think of none more mellifluous and appealing, so I recommend it to you all.

HOW WE MEET

For those who want meet earlier there is the coffee-shop/book shop on the ground floor, and the meeting room itself is available to us from 1.30 pm. There is a basement restaurant with nice food costing around £6.50 for a main course, open at 12.00. This will be our fourth meeting and attendance so far has been in line with our expectations, bearing in mind that there hasn’t been much publicity.

A group of seven people (such as met in October) makes for a congenially intimate encounter, even when most people are strangers to each other. Not having an agenda encourages those present to use the opportunity for dialogue, to listen carefully to other points of view and experience, to see the world through other eyes. In these conversations buddhadharma is our point of departure, not our destination.

By this I mean that the meetings aren’t intended to deliver teachings , and there are no readings or planned expositions on the tenets of Buddhism. Stephen Bachelor (see below) speaks of ‘beings who inhabit a participatory reality, seeking relationships that enhance our sense of what it means to be alive’.

This, for me, clearly expresses the meaning of our meeting, a temporary mandala of participatory reality, within which we can share our aliveness, “women and men living in the here and now” as Ray Wills used to put it.


MEETING AS STIR-FRY?

Before Mick suggested Mandala as a title, I had been thinking of the meeting in terms of a stir-fry. For a stir-fry, small amounts of fresh raw ingredients, whatever is to hand, are thrown into the wok in which a little oil has been heated over a fierce flame. That’s what the meeting feels like, a wok!

Each of us (who wants to) tosses in a handful of fresh stuff we‘ve plucked from our lived experience: something leafy, crunchy, moist, dry, sweet, tart, sour or fragrant; maybe it’s just a pinch of something fiery, spicy, aromatic or piquant, something to tease and tantalise, to make the juices flow. Those who don’t want to speak supply the wholesome oil of their silence.

Our tacit expertise comes (I think) in how we judge when to tilt the wok, how to stir the contents, how much (if any) of what we bring to throw in the wok, how high we set the flame, and how we judge when enough is enough. No single hand does this, or it does itself, the cooking sizzles and steams, the ingredients are balanced ‘just-so‘, and no meal is ever the same.

I like to think we can all ‘eat’ from the same dish, without being formally invited, that what we ‘eat’ is good for us, and I hope that you think so too. If this makes anyone feel hungry, I should add that we do supply tangible as distinct from fanciful refreshment (hot drinks and nibbles) and people sometimes bring a little food to share (but not a lot please because the Friends aren’t keen on our doing this, although it’s OK as long as we take clear up after ourselves when we leave)

JUST AS THE DAWN…..

During the last meeting I had a telephone call about my youngest brother, who is dying at home from advanced pancreatic cancer. This near-at-hand encounter with a dying sibling (he is 11 years my junior) has shown me how deep and convoluted run the dynamics of my family life; how, since I learned of his terminal condition, mental processes have gone on in me without my being fully aware of them, sometimes throwing me into confusion and paralysing my intention; and how important spiritual friendship is in making sense of one’s feelings, thoughts, reactions and impulses.

I pay tribute here to the friend I talked with on that Saturday, and to the way our conversation opened my eyes and helped unburden my heart. Thank you.

Spiritual friendship is at the heart of our hospice work, in fact it is all of it, because we don’t as a Trust aspire to professional involvement with the dying, although some supporters do so in their own right as doctors, nurses, counsellors, therapists etc. Below I am copying an article by Stephen Bachelor that I think captures the essence of spiritual friendship exactly, and I hope you enjoy reading or revisiting it, and feel uplifted by his words.

SPIRITUAL FRIENDSHIP (by Stephen Bachelor)

JUST AS THE DAWN is the forerunner of the arising of the sun, so true friendship is the forerunner of the arising of the noble eightfold path. - The Buddha

"These friends are teachers in the sense that they are skilled in the art of learning from every situation."

Dharma practice is not just a question of cultivating resolve and integrity in the privacy of our hearts. It is embodied in friendships. Our practice is nourished, sustained, and challenged through ongoing contact with friends and mentors who seek to realize the dharma in their own lives. We were born alone and will die alone.

Much of our time is spent absorbed in feelings and thoughts we can never fully share. Yet our lives are nonetheless defined through relationships with others. The body is witness to parents and endless generations of forebears, language witness to fellow speakers, the most private thoughts witness to those we love and fear.

Simultaneously and always, we find ourselves alone with others. We are participatory beings who inhabit a participatory reality, seeking relationships that enhance our sense of what it means to be alive. In terms of dharma practice, a true friend is more than just someone with whom we share common values and who accepts us for what we are.

Such a friend is someone whom we can trust to refine our understanding of what it means to live, who can guide us when we’re lost and help us find the way along a path, who can assuage our anguish through the reassurance of his or her presence. While such friendships occur naturally between peers with similar aspirations and interests, certain crucial friendships are also formed with those we respect for having achieved a maturity and understanding greater than our own.

Such people offer guidance and reassurance through each aspect of their being. The way they move their body and hold our gaze with their eyes, the cadences of their speech, their response to sudden provocation, the way they rest at ease and attend to daily chores: all these things tell us as much as they tell us in words. And we too are called upon to respond in such ways. In this kind of relationship we are no mere recipients of knowledge. We are invited to interact, to challenge and be challenged.

These friends are teachers in the sense that they are skilled in the art of learning from every situation. We do not seek perfection in these friends but rather heartfelt acceptance of human imperfection. Nor omniscience but an ironic admission of ignorance. We should be wary of being seduced by charismatic purveyors of Enlightenment. For true friends seek not to coerce us, even gently and reasonably, into believing what we are unsure of.

These friends are like midwives, who draw forth what is waiting to be born. Their task is not to make themselves indispensable but redundant. These friends are our vital link to past and future. For they too were nurtured through friendships, in many cases with those who are dead. Dharma practice has survived through series of friendships that stretches back through history – ultimately to Gautama himself.

Through friendships we are entrusted with a delicate thread that joins past with future generations. These fragile, intimate moments are ones of indebtedness and responsibility. Dharma practice flourishes only when such friendships flourish. It has no other means of transmission. And these friends are our vital links to a community that lives and struggles today

Through them we belong to a culture of awakening, a matrix of friendships, that expands in ever wider circles to embrace not only “Buddhist” but all who are actually or potentially committed to the values of dharma practice. The forms of this friendship have changed over history. The dharma has passed through social and ethnic cultures with different ideals of what constitutes true friendship.

Two primary forms have emerged: the fellowship model of early Buddhism and the guru-disciple model of later traditions. In both cases, friendship has become entangled with issues of religious authority. Before the Buddha died he declared that the dharma would suffice as one’s guide. In the early community, friendship was founded in common adherence to the rules of discipline the Buddha devised to support dharma practice.

The community was a fellowship of brotherhood and sisterhood, under the formal guidance of a paternal or maternal preceptor. While the system reflected the hierarchy of an Indian extended family, in which everyone deferred to seniority, the final authority lay not in a person’s position in the hierarchy but in the rules of discipline. True friendship was modelled on the relationships among siblings and between child and parent, with the difference that all were equal in the eyes of the dharma and subject to its law.

After about five hundred years, the Indian guru-disciple model was adopted by certain schools. Here the teacher became a heroic figure to whose will the student surrendered as a means of accelerating the process of awakening. This relationship reflected that between master and servant or feudal lord and subject. The different degree of power between guru and disciple was utilized as an agent of personal transformation. Elements of dominance and submission (and with them the concomitant danger of coercion) came to characterize the notion of true friendship. If, after close examination, your accepted someone as your teacher, then you were expected to revere and obey him.

In varying degrees, the authority of the dharma was replaced by the authority of the guru, who came, in some traditions, to assume the role of the Buddha himself. Despite the contracting nature of these models, in practice they coexisted. As a follower of the Buddha’s rules of discipline, a true friend was accountable to the community and the dharma, but as a guru was impervious to any critique formulated by the deluded mind.

Most traditions of Buddhism today represent one of these ideals of friendship or a blend of the two. In the contemporary secular, democratic societies, such traditional models of friendship are bound to be challenged. For we may no longer feel at ease in friendships defined by the hierarchy of an extended family, the rule of law, or submission to the will of another. We may no longer feel the need to wear a uniform or in any way sacrifice our ordinariness.

Exotic names, robes, insignia of office, title – the trappings of religion – confuse as much as they help. They endorse the assumption of the existence of an elite whose explicit commitment grants them implicit extraordinariness. It is not just different circumstances that raise questions about the nature of true friendship. Of greater significance is that we notice that circumstances are different. Historical consciousness itself makes the difference.

It is no longer possible to maintain that dharma practice has remained unaltered since the time of the Buddha. It has evolved and continues to evolve distinctive forms peculiar to the conditions of the time. It has survived precisely because of its ability to respond creatively to change. What features of contemporary life are most likely to affect the concept of true friendship? Mutual respect for the creative autonomy of individual experience would take precedence over submission to the dogmas of a school or the autocratic authority of a guru.

The responsibility of a friend would be to encourage individuation, self-reliance and imagination. Such friendship might be informed by notions such as martin Buber’s “I-Thou” relationship and the French Catholic philosopher Gabriel Marcel’s ideal of “availability” for another. Its practice may draw on the experience of psychotherapy, in which a “free and protective space” allows an encounter that is simultaneously trusting, opening, and healing.

For learning and training, it may take as its model the relationship of artist and apprentice, in which skills are developed so that creativity can be realized with technical competence and expertise. Whenever Buddhism has become a religion, true friendship has tended to be compromised by issues of power. Both the fellowship and guru models have given rise to large, impersonal, hierarchic, and authoritarian bodies governed by professional elites.

In many cases, these institutions have become established churches, sanctioned and supported by sovereign states. This has often led to rigid conservatism and intolerance of dissent. This process is not inevitable. It is also possible to imagine a community of friendships in which diversity is celebrated rather than censured. In which smallness of scale is regarded as success rather than failure. In which power is shared by all rather than invested in a minority of experts. In which women and men are treated as genuine equals. In which questions are valued more than answers.

ENDPIECE

We are grateful for your contributions towards our work, including the costs of hiring the room for our meeting, currently around £70 per session.Your attendance, your presence, is especially precious. I hope you will want to come again, and will be able to. Remember that every meeting is free-standing and there is no need to keep up regular or frequent attendance. Feel free to bring along a friend at any time without prior arrangement.

We shall welcome your ideas for public meetings or seminars on topics of interest that have relevance for our work, although we don’t usually host dharma expositions by teachers of lineage or otherwise, and we are not able to pay fees to speakers (although we will cover travelling expenses).We are also on the lookout for short articles or other contributions written by supporters to feature in our newsletter ‘Mustard Seed’ which will be published shortly. If you send these to me I will pass them on to the ‘editorial team‘.

Here to help! Some searching questions...

The following questions came to us from someone embarking on a research exercise into hospice development, and I attach my responses (for what they are worth). The questions were sincerely put, and I hope that my unvarnished responses have not dampened the enthusiasm of the researcher to enquire further.

What do you see as the most challenging aspect of your work with the dying?

Difficult question to answer.

Working with people in crisis is always something of a challenge to all involved. Dying is a crisis in the same way most of the rest of life throws up situations of challenging change, crises. Dying isn't qualitatively different, and Buddhism teaches us not to see death as something essentially different. The way people deal with dying is the way they deal with all crisis. We are creatures of habit. As we live, so we shall die. But perhaps Buddhists learn through their practice that they don't have to be challenged by change; indeed, Buddhism has acceptance at its heart. In acceptance nothing challenges, and there is no-one to be challenged.

Practice isn't easy, so perhaps that's the everyday challenge, to do what we can to practice, whatever we understand that to mean. And that's a challenge too, understanding what it means to practice. It isn't bowing, making obeisance to the Buddha, or sitting on the cushion.

What is - in your religion/spirituality - the most important aspect of the dying process?

It's important not to get hung up on 'the dying process', whatever that means. Dying is a normal physiological process and there's no part to which it is worth attaching symbolic importance, or thinking it is more important than another. The question arises out of the tendency on the part of many Buddhists to take teachings about the bardos too literally. One might quite as earnestly ask "What is the most important part of the process of evacuating the bowels?" Or, "what is the most important part of the process of digesting one's dinner?"

As a nurse I have attended the deathbeds of very many people, and death - you can rest assured - is always 100% successful. Every death is unique, and the process may be very drawn-out, or it may (of course) be instantaneous, as in a plane crash or 9/11. It doesn't matter how we die, what matters is how we live. I don't think the Buddha had a lot to say about deathbeds.


What are the most recurrent problems you are facing with dying people?

There are generally no problems to be faced with dying people except the usual ones such as "If I am visiting shall I find a place to park?" or, in my case, "Will my wife get irritated that I am not at home to help her with the household chores and domestic worries she has to face alone because I am attending to my "good works" with others?" You may have heard the Bible saying ascribed to Yeshwa (Jesus), "Leave the dead to bury their dead". It makes a lot of sense.

As the Chairman of a Buddhist charity, it is sometimes a problem fending off Buddhist volunteers who want to be "in on the act" at other people's deaths. If you ask them to address envelopes, wash up or serve tea they feel snubbed and hurt, that they have some special gift to impart, and you are standing in their way! Not all volunteers are like this, of course, but it is disheartening to find how many are.

Which are the situations in which you find yourself helpless?

Helplessness is a most desirable default mode to cultivate when being with the dying.

There is nothing to do, so the mind of helplessness is entirely congruent with that. "Doing less, being more" is the motto. If we can cultivate a heart of helplessness compassion will flow into it and, in that heart of compassion, 'helper' and 'helped' will encounter each other without distinction and in perfect reciprocity.

How supportive/unsupportive do you consider your society with death, religious approach to death, and religions in general?

Our own (British) society has been greatly shaped by Christendom including the tenets of Christian belief and doctrine, in their many vernacular forms, and there is no doubt in my mind that established religion in UK does provide a framework for many in helping them to find meaning and consolation in suffering and loss. Some individuals find it difficult to talk about death, to talk naturally to a person who has been bereaved and so on, and this reticence is part of the way people feel about death; it is not our part to judge them, or to characterise them as unsupportive. People have a right to their feelings, and there is nothing wrong with the way they behave.

I have deep admiration for Christian clergy and for many church-goers. I don't find that Buddhists are better at dying and death and supporting others than members of other faiths. Some are very good, some less so. I think that humans (regardless of their religious affiliations or lack of them) are on the whole infinitely capable of acceptance, equanimity, "courage", and of healing into their true nature.

Although I'm a Buddhist and it has worked for me, it's my point of departure in what I do, and I have no interest in or ambition to convert others to Buddhism. I lived and worked in Africa for many years, where Buddhism is just unknown. But the people there live richly-engaged dharma lives, and have no need of the teachings of Gotama to guide them away from what they know and do.

What do you think could be common ground for our different religions to expand our support in hospice work?

Our common humanity supplies enough ground, I think, for interfaith cooperation and mutual support in the face of suffering. Suffering feels and looks the same in all creeds. We don't need to wrestle with conceptual issues, indeed, they get in the way of collaboration.

There are certain principles of the hospice movement, and of the palliative and "end-of-life-care" movements, that are worth fostering because they have made a major difference to terminal care. Hospices as institutions where people go to die, however, are giving way (for various reasons including cost) to death at home, or in some other 'preferred place', as the spectrum of care-provision changes in line with popular choice, and improved technology.

How do you deal with mental and spiritual suffering in your work with dying people? What are the words and attitudes that seem to relieve anxiety, fears and agitation?

How do you, the questioner, distinguish mental and spiritual suffering? My question is intended to challenge you, the questioner, out of a state of mind that reduces life to a number of discrete compartments or categories that call out to be 'dealt with'. I don't intend to insult or attack you, and I know you are in a reflective situation, and just putting your toe in the water. But I think you are also robust enough to follow my drift.

Suffering does not call for formulaic responses, words, attitudes or theories. I can only be alongside the one who suffers, and dwell with her/him. In helplessness the words and actions may arise that are fitting, appropriate or 'helpful'; but they will be uncontrived, not 'mine', not to be held on to. Buddhism has nothing 'off the shelf' to offer, does it? The following true anecdote illustrates the folly of taking a 'cook-book' approach to death, however eminent the 'cook', and however well-intentioned the recipe.

I once met a very devout and kindly Buddhist woman who, when her old Glaswegian mother was dying, plucked up her courage to begin reading her Mam a few words from the Tibetan Book of Living and Dying. Her mother opened her eyes, gazed steadily at her daughter and said in a clear voice, "Aye, and ye can fuck off dearie, and tak' yer fucking book wi' ye!" That old dying woman was Buddha, and her daughter never forgot the lesson she was taught that day. Talk about enlightenment!

What has changed for you from your experience of dying people?

Well, I have never sentimentalised death, and I don't put dying on some sort of pedestal. I have come to understand that death takes care of itself and needs no facilitation. Death is good, death is kind, or so it seems to me. Dying may be difficult, and in some cases it presents difficulties for which there may be remedies, e.g. pain and symptom relief. People often need good nursing care. People largely prefer to die at home (if they can be adequately cared for at home), and this has affected the way hospices are funded and operated.

People who are dying appreciate the friendship and support of others who come with no helping agenda, no spiritual mouthings, no religious templates of belief or doctrine to pass on, no formulas, interpretations or solutions. Such people are rather rare, including amongst Buddhists.

And, to quote Christina Feldman, "We are always beginners in the art of compassion".

Is there any aspect of Buddhism that you feel may be particularly useful with dying
patients?

No, no agenda, no special tool in my tool box. Possibly I might remind myself often that Gotama said "No person can save another. Work out your own salvation, with diligence".

"Toxic Debt" and other lies...

The image is of Winter in Glen Etive, Glen Coe by courtesy of D W Roberston Gallery and is an illustration for Tales of Travel (see below)


As I write news is coming over the radio about the resue plan put together in the US to save international markets from melt down, or whatever other thermodynamic metaphor is appropriate for this jolt out of the consensus trance we've all been in for the last thirty or so years, or longer.

I have the powerful feeling that the explanations we're being given for what has happened to the 'markets', and what we need to patch things up, is another deliberately administered dose of anaesthetic. The problem, we're being told, is that banks are no longer willing to lend each other money, and this 'freeze' is the cause of the problem.

At the heart of the crisis, allegedly, is "toxic debt", debts built up by poor people who were bamboozled into mortgages they couldn't afford, and can't repay. This level of "toxic debt" has "infected" the global financial system. I find it outrageous, but perfectly in keeping with the evil tenets of capitalism, that this language of poison and contagion should be used to define the heart of the problem; to denigrate and scapegoat the hapless undeserving poor, those who wanted to house their families, low-paid workers, single mothers, people from ethnic minorities.

The implication of what we're being told seems to be that banks actually have lots of money, but they don't trust anyone enough to lend it, including each other, because toxically infective "sub-prime" borrowers have contaminated the system, defaulted on loans, and infected the system like a type of rabies, paralysing it like 'lock-jaw'. So the banks are are sitting helplessly on the money they have left. The result is that no-one can borrow any more, so they have none to spend or 'invest'. There is, or soon will be, no money in circulation. Money has somehow congealed, clotted up.

The proposed solution seems to be that Governments will give a very large amount of money - "taxpayer's money" - to the banks. This is called "injecting liquidity" into the system to "lubricate it" or "free it up" or some other inane slogan borrowed from hydraulic engineering. This money will somehow, miraculously unblock the clogged-up system, and money will once again flow.

Presumably this borrowed money will be used to lend to other people, so that banks will "regain the confidence they need" to begin "lending money to each other", re-establish "confidence in the system" and everything will be AOK again. Except that you and I will be expected to pay for it through taxation, the privatisation of services, and the life-long indebtedness of our children.

Does anyone believe this anaesthetic nonsense? That the banks have money but are too mistrustful to lend it? That they need to be given money to steady their palsied nerves?

Well, I believe that in truth there is no money. The money that the banks and building societies have been lending to people doesn't exist, and never has. The money on your mortgage statement, or in your deposit account, the "equity" in your house, or the figure on your ISA certficate is just a mirage. Since the "Big Bang", money has just been an illusory row of noughts on the computer screen, from which people in the City and on Wall Street have been regularly helping themselves to huge tranches in currency bills, to buy or build mansions, Rolex watches, Maseratis and diamond encrusted crystal skulls as gee-gaws.

It seems to me that what is proposed is the launch of another illusory capitalist spree, a re-instatement of the status quo ante, business as usual in Wall Street and the square mile, a short term boom in the High Street as consumers "regain the confidence" they need to put a spring in their step in the long run-up to Christmas (expect the tinsel, toys and mince pies to greet you in Tescos, Wal-Mart and Sainsbury's soon enough). And the directors (and highly paid non-Execs like Tony Blair) will laugh all the way to their non-dom banks and off-shore Cayman Island havens.

What has this got to do with Buddhism? Well, as I said in an earlier post on the Social Care Green Paper, perhaps it's about seeing the world, or not seeing the world, from any perspective, but recognising that this is what we always do and recognising this, opening ourselves to the possible emergence of another way of being. As Ray Wills used to say "There must be another way". He didn't define what that other way might be because the Way doesn't have a destination in mind: it's a point of departure, an open road. What we can do (but it's hard and calls for energy and resolve) is to allow ourselves to open to another way of being, not adopting it or 'trying to' follow it, but rather becoming it.

A howl of outrage? An intemperate polemic? Well, yes, perhaps. But I'm human, and it's part of my way of opening up to another way being, and perhaps helping you, who knows. So I'll let it stand, and finish on a quieter note with the words The Vagabond, part of a song-cycle of verse (Songs of Travel) by R L Stevenson, set to music by a favourite composer, Ralph Vaughan Williams, and with the cool illustration of Glen Coe (above) as backdrop:

Give to me the life I love,
Let the lave go by me,
Give the jolly heaven above
And the byway nigh me.
Bed in the bush with stars to see,
Bread I dip in the river -
There's the life for a man like me,
There's the life for ever.

Let the blow fall soon or late,
Let what will be o'er me;
Give the face of earth around
And the road before me.
Wealth I seek not, hope nor love,
Nor a friend to know me;
All I seek, the heaven above
And the road below me.

Or let autumn fall on me
Where afield I linger,
Silencing the bird on tree,
Biting the blue finger.
White as meal the frosty field -
Warm the fireside haven -
Not to autumn will I yield,
Not to winter even!

Let the blow fall soon or late,
Let what will be o'er me;
Give the face of earth around,
And the road before me.
Wealth I ask not, hope nor love,
Nor a friend to know me;
All I ask, the heaven above
And the road below me.

Tacit knowledge

It has been a pretty exhausting week at my place of work, with a spate of sickness affecting several of the carers, so that everyone unaffected has had to pitch in to cover for absent colleagues, work extra shifts, and generally 'burn the candle at both ends'. In the last weeks I have worked several back-to-back shifts of fourteen consecutive hours duty, mostly engaged in 'hands-on' care, interspersed with such activities as helping to cook and serve meals, wash up pots, pans and dishes, do laundry, and variety of administrative chores besides.

At such times nerves can get frayed, patience is strained, and mistakes and accidents are more likely to happen. This morning, arriving at work at about 0645, I looked in on the laundry room to find that one of our washing machines had been loaded with two sets of nightclothes, both of which sets had been subject to a hot wash while still containing incontinence pads, which ought to have been removed. These 'pads' are disposable adult garments like large 'nappies' made of cellulose padding inside a thin plastic envelope, designed - of course - to capture and contain human wastes.

Presumably the overworked and overtired careworker who did the washing had been too distracted to remember to separate out the pads from the garments so as to put them in the clinical waste bin. Of course, they had disintegrated in the machines, dispersing the contents throughout the wash, and liberally coating the inside of the drum with unpleasant emulsified pap. Not a bright start to the day, but not unusual either.

After work this evening I turned to an article in my daily paper, hoping to take my mind off things clinical, but my eye was caught by an article, a critique, about the training of young doctors. Not a lot has changed in the fifty or years I have been in a position to observe this happening except, perhaps, that doctors have grown unaccountably younger, like policemen. Training is still very much hospital-based, and possibly even more fragmented and modularised than ever, with more tick-box-type assessments, and less time at the bedside.

Patients are in hospital for much shorter periods than twenty years ago, so that doctors have less time to get to know their charges, less time to see changes in their patients over time, for getting a feel for how people respond over time to disease, and watching what happens as they get better. The wisdom that emerges from being able to witness such evolutionary change is called "tacit knowledge".

One of its characteristics is a growth in the necessary humility that a practitioner develops about her own part in the processes of recovery and 'cure', and a deeper respect for the adaptive potential of the human organism, in both the physical and the psychological domains. Medicine, after all, is just a set of interventions that help to put the patient into a condition that allows nature to take its healing course. The same is true of nursing and all 'healing arts'.

In this respect, I believe, nurses are at an advantage over doctors, and many doctors (certainly most senior or older doctors) acknowledge the wider and deeper clinical acumen of nurses in making a difficult diagnosis, and a more reliable prognosis, than less seasoned doctors. Nurses, unlike doctors, see their patients day-in-day out, are privy to their informal conversations and reflections, and see them in a far wider repertoire of activities than doctors, sleeping, eating, eliminating, attending to their own needs, in relation to their families etc. Unfortunately, changes in the way nurse training has been structured and delivered have made for a much less coherent and "wholistic" relationship between nurse and patient, less physical intimacy, less thorough-going trust and rapport, and less of a long view on events in the curriculum of health and illness.

There are times when I am attending to one of my own patients, that I am thrown back in my experience to an earlier time when I first began to learn to nurse, fifty years ago. It's not memory in the sense of a picture in the mind, it's a felt physical thing, a reassurance of close contact, warmth, the complex scent of a close-held body, the touch of skin, awareness of a tremor, of a small weakness, of effort, of courage that always springs up in the other to meet the challenge of the moment, and something eternal too about trust and vulnerability.

Today I was helping an old fellow off his commode, helping him hitch his underpants and trousers up, his head against my chest, his arms round me in a politically incorrect and improperly conducted lift by Health and Safety rules, telling him, when he said "You know how to help me", "Yes, we know how to work well together", and meaning it, and knowing it's meaning is not to be found in me, but in the way things are, in that tacit knowledge, that unspoken wisdom that pervades everything, and always. Help is not something I do to another, it's a resource two people in a relationship share, born of the relationship and its circumstances, and always in perfect reciprocity, whatever happens.

"Though the Path is vast and fathomless I vow to understand it.

Though enlightenment is beyond attainment I vow to embody it fully."

Social Care Green Paper

The diagram to the left is a representation of an aspect of the social care market, courtesy of Healthcare Economist Journal of the United States

Eminent Buddhist commentator and analyst Yann Lovelock has written to us inviting us to contribute to a discussion promoted by Government on the future of social care for old and very old people in our society. The link leads to a short introductory vox pop video in which a number of people offer views on the issue, framing the discussion, and linked to a site that presents the issues from the perspective of the working party preparing a Green Paper. The Green Paper is part of a process by which enabling legislation will be worked up, and services designed, to meet our social care needs in the years ahead.

As Yann reminds us, some of us will soon be facing questions of what care we need, what is available, what it is going to cost, and who will foot the bill. Some of us, of course, are facing these issues already.

These questions have been framed for us by the consultation document, and seem to me to have a very New Labour quality to them, in that they arise from a set of political assumptions about the meaning of care i.e. care as a commodity that individuals will want to buy, exercising choice over their purchases, purchases designed to support their independent living, a 'marketplace' for the setting out of care-wares, care-tariffs and so on (some of these terms are my own, I must confess).

Buddhists may want to challenge these assumptions, although they may not, of course. We are all used to viewing the world, its affairs, and our atomised part in those affairs, through a narrow slit of social and political conditioning. We constantly absorb through the media of TV, press, advertising and the Internet an insistent paradigm of existence that stresses individualism, consumer choice, competition, and the all-defining lifestyle.

I live my life mainly as a consumer; I can't help it. Although I make efforts to break out of consumerist samsara, it is deeply engrained, and I have no illusions about my intentionality or volition, which is weak and intermittent. My puny efforts are debilitating and discouraging, I often feel flaked out and hopeless.

But fettered as I am by the chains of my mind, I find that I must protest, even though I can't find the words to do so, except in the anguished cry,"There must be another way"!

I feel, I intuit, that there is another way to characterise care, a framework that expresses our interdependence, our shared vulnerability, our willingness to let go of the pride and intellectual arrogance that puts independence and individualism on a lofty pedestal, that "knows the price of everything and the value of nothing". I can not accept that care is, or should be, a commercial transaction, bound by contractual criteria, published as a menu of bite-sized interventions, packaged, audited, regulated, costed, 'branded', advertised, "starred", charter-marked and "visioned".

There must be another way.

N.B. I shall welcome your views, opinions and sugestions and, if you agree to my doing so, I will add them to views I am collating on behalf of the Network of Buddhist Organisations as a response to the Green Paper consultation. Or you can send them directly via the link given above.

De mortuis nil nisi bonum

Speak only well of the dead. This came to mind today as I read a quite lengthy broadsheet obituary which ended as follows: "At one time he owned a parrot with a penchant for fried eggs and Guinness. His wife Doris died in 1992, and he is survived by his son, Andrew."

That I should ever deserve such such an eloquent summation! "At one time he owned a small knife with a bone handle, a gift from his school-friend Roger, who had bought it on a holiday visit to Switzerland with his father, an industrial glass salesman."

I was at the second meeting recently of the reconstituted "Inner Work School" meeting, held on the second Saturday of each month in Friends House, Euston Road. It was good to meet old friends again under familiar circumstances, albeit a new venue, paid for by the Buddhist Hospice Trust. It was also good to meet up with newcomers, thanks to the efforts of Ben (Bodhiprem) Shapiro and Mick Lewin in publicising the event, and convening the meeting.

By all accounts, the 'mood' of the first meeting was for open discussion to an emergent agenda, and the meeting I attended was carried on in this way too. It's hard to see how, with a fluctuating membership and no chairperson, an agenda could be developed that carried across meetings. But we shall see what emerges over time. For myself, I have enjoyed these gatherings, and got benefit from them, in ways hard to describe.

I know they have contributed to that softening of opinion in me that Buddhist practice produces, so that I can listen to the opinions of other people with something akin to empathy: it's like seeing the world from another point of view, through different eyes, and not in competition with one's own perspective. This is by no means my default position, I am almost if not fully as combative and confrontational and contraversial as I've always been; but there has been a change. Of course I am still always right, but other people have gradually much nearer to my position than they used to be, thus their expressions of dissent are more bearable.

"At one time around 1956 he owned a secondhand collarless Gieves shirt in a narrow blue stripe, which he wore with a white starched collar secured with a stud, loooking very much (as he thought) the fashionable young man-about -town, especially as he carried a rolled umbrella."

Am I alone in sensing a change in the temper of society since the "credit crunch" began? There seems to me to be a sense of sober expectancy amongst my fellows as I move about the town to do a bit of shopping or to pay bills. Do I also sense a "rabbit in the headlamps" paralysis in the unconvincing (and unconvinced) utterances of our national leaders? As if they understand the enormity of the show-down we face in the crisis of capitalism, the imminence of irreversible climate change, the here-and-now inescapability of 'peak oil', but lack the courage to do anything about it. The best thing would be to come clean, to spell out the situation, and to ask us to begin to develop ways of coping with a new reality. Offering structures that would mobilise our efforts for survival or, if we are not to survive, for a dignified extinction, worthy of a noble if flawed species. What might be our epitaph then?

"At one time he owned a portable Olivetti typewriter in a faux pig-skin carrying case, bought on Hire-Purchase terms from a door-to-door salesman who visited his rented flat in Moseley, Birmingham, in the autumnn of 1962."

The Buddhist Hospice Trust Blog: Mrs Waveney Miller

The Buddhist Hospice Trust Blog: Mrs Waveney Miller

Stephen Hodge, who was Waveney's first and much-loved teacher, has sent some kind and corrective comments on my earlier blog, and these can be read in full using this link. Thank you Stephen.